Medical Oncologist
Biomarker & Molecular Testing
What Is NGS Testing — and Do You Need It?
Next-generation sequencing reads the molecular fingerprint of your tumour in one test. It can find a mutation your oncologist can match to a targeted treatment — but it is not the right test for every patient, and results take time.
Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed August 2026
- One test, thousands of genes — NGS reads hundreds to thousands of gene mutations at once, rather than testing one gene at a time.
- Not needed by everyone — Your cancer type, stage, and what testing has already been done all affect whether NGS adds useful information.
- Results take time — Comprehensive NGS panels commonly take two to four weeks — this matters when treatment decisions are pressing.
- A result is not a treatment plan — Finding a mutation does not automatically mean a drug exists or is approved for your cancer in India.
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NGS — next-generation sequencing — reads hundreds to thousands of genes in your tumour tissue at once, looking for mutations that may match a targeted treatment. It gives a fuller picture than single-gene tests. Your oncologist recommends it when your cancer type, stage, or treatment history makes a broad molecular profile likely to change your plan.
What does NGS actually look for in your tumour?
Your tumour has accumulated mutations in its DNA — small errors that made those cells grow out of control. Some of those mutations are the same ones that targeted drugs are designed to switch off.
NGS reads the DNA from your tumour tissue or, in some cases, from a blood sample. It generates a list of mutations that your oncologist and a molecular tumour board then interpret against available treatments and trials.
The mutations NGS finds include gene fusions, copy number changes, and variants that predict whether specific drugs are likely to help. It also reports markers such as tumour mutational burden and microsatellite instability, which predict response to immunotherapy according to NCCN and ESMO guidance.
When your oncologist is likely to recommend NGS
- Your cancer is at an advanced or metastatic stage
- Your cancer type has known targetable mutations — for example, lung, colorectal, breast, ovarian, or cholangiocarcinoma
- Standard first-line treatment has stopped working and your team is considering what comes next
- Your cancer is rare or the original site is unknown, and a molecular profile may guide treatment
- You are being assessed for a clinical trial that requires specific biomarker data
- Single-gene or small panel tests have already been done and a wider picture is needed
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Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.
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Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
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Dr. Mohammed Imran
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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How does NGS compare to other molecular tests?
| Single-gene test | Targeted panel (20–50 genes) | Comprehensive NGS (300+ genes) | |
|---|---|---|---|
| Genes examined | One gene at a time (e.g. EGFR only) | A curated set for one cancer type | Hundreds to thousands across cancer types |
| Typical turnaround | Faster — commonly one to two weeks | Moderate — commonly two to three weeks | Longer — commonly three to four weeks |
| Indicative cost | Lower | Moderate | Higher — the most comprehensive option |
| Tissue needed | Small sample usually sufficient | Small to moderate sample | Adequate sample needed; liquid biopsy available for some panels |
| Best suited for | When one known mutation guides a specific drug decision | When your cancer type has well-mapped targets | When a broad search may reveal an unexpected match or trial option |
| What you receive | Positive or negative for that one gene | Results for genes on that panel only | Full molecular profile with interpretation across cancer types |
What your result means — a what-if guide
What if NGS finds a mutation with a matching drug?
This is the outcome the test is looking for. Your oncologist will then check whether that drug is approved by CDSCO for your specific cancer type. A mutation that matches a drug approved in a different cancer may still be actionable through a clinical trial, but it is not the same as an approved treatment. Ask your team three separate questions: Is the drug approved for my diagnosis? Is it available in India? Is it covered by my insurer or government scheme? All three matter before you can act on the result.
What if NGS finds mutations but none have a drug attached?
This is a common result and does not mean the test was wasted. Some mutations confirm that a standard treatment is likely to work, or that a particular drug should be avoided. The result also becomes a permanent part of your medical record — if a new drug is approved later, or a clinical trial opens for which your profile qualifies, your oncologist already has the data. Ask what the mutations found mean for your current plan, even when no new targeted drug is indicated today.
What if NGS comes back with no mutations found?
A negative result means no actionable mutations were detected on the panel that was run. It does not mean your cancer has no molecular characteristics — it means none that this specific panel tests were found. Your oncologist may consider whether a different test is appropriate, or may confirm that the planned treatment remains the right choice. A negative result is a legitimate clinical answer, not a test failure, and it can shorten the time to starting treatment.
What if the sample is insufficient for NGS?
NGS requires a reasonable amount of good-quality tumour tissue. If your original biopsy sample is too small, degraded, or heavily processed, the laboratory may report an insufficient result. Your team will discuss whether a repeat biopsy is warranted, or whether a liquid biopsy — testing tumour DNA shed into the bloodstream — is an appropriate alternative. Not all cancers and not all mutations are detectable on liquid biopsy, so the choice depends on your specific situation and what question needs answering.
What if results take longer than expected?
NGS is a complex laboratory process and delays happen, particularly if the sample needs to travel to a specialist laboratory or requires a repeat run. If your treatment plan depends on the result, ask your oncologist whether there is an appropriate interim step while you wait, or whether a faster single-gene test could answer the most urgent question first. Waiting weeks when treatment is pressing is a real concern — raise it directly rather than assuming the delay cannot be shortened.
What if your oncologist does not recommend NGS?
This is often the right clinical call. For early-stage cancers with a clear standard treatment, NGS rarely changes the plan and the wait adds time before starting. For cancers where no targeted drugs exist, a broad molecular profile does not usually help the immediate decision. If the recommendation has not been explained to you, ask which tests have been done, what they showed, and what would need to change for NGS to become relevant. A second opinion from a molecular oncologist is reasonable if you remain uncertain.
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Common questions
Frequently asked questions
How long does NGS testing take?
Comprehensive NGS panels commonly take two to four weeks from when the laboratory receives your sample. The timeline depends on whether the sample needs to travel to a specialist laboratory, the quality of the tissue, and whether any step needs to be repeated. If your treatment decision is urgent, ask your oncologist whether a faster single-gene test can answer the most pressing question while the full panel is processed in parallel.
How much does NGS cost in India?
Cost varies considerably by the panel used, the laboratory, and whether testing is ordered through a government scheme or privately. Comprehensive panels cost more than targeted panels. Some state government cancer schemes and CGHS cover NGS for specific cancer types — ask your hospital's billing team before assuming you will pay the full amount out of pocket. Any figure you are given is indicative and subject to change, so confirm at the time of ordering.
Is a blood test enough, or do I need a biopsy for NGS?
Most NGS panels use tumour tissue from a biopsy, because DNA from the actual tumour gives the most complete picture. Liquid biopsy — testing tumour DNA shed into the bloodstream — is available for some panels and suits situations where a biopsy is not safely possible or when monitoring a known mutation over time. Liquid biopsy does not always detect all mutations that tissue testing would find, so your oncologist will advise which sample type is appropriate for your situation.
Does a positive NGS result mean a targeted drug will definitely work?
No. Finding a mutation tells your oncologist that a drug may be relevant — it does not guarantee that the drug will control your cancer. Response depends on factors beyond the mutation alone: how the drug reaches the tumour, what other mutations are present, and the cancer's overall behaviour. NCCN and ASCO guidance frames a matched mutation as a reason to consider a drug, not proof that it will work. Your oncologist will explain what the result suggests without overstating what it can predict.
Can my NGS result become outdated if the cancer changes?
Yes. Tumours change over time, and a cancer that has been through chemotherapy or targeted therapy may have acquired new mutations. A result from two or three years ago may not describe the disease you have now. If your cancer has progressed or changed behaviour, ask whether repeat molecular testing is warranted. Some mutations that were absent at diagnosis appear at relapse, and new targeted drugs are approved regularly, so an older profile may be worth revisiting.
Should I arrange NGS privately if my hospital has not offered it?
Before arranging private testing, ask your oncologist two things: whether NGS is indicated for your cancer type and stage, and whether an adequate tissue sample is already available. If NGS is not indicated for your situation, paying privately rarely changes the plan and adds weeks to the timeline. If it is indicated and was not ordered, ask why — there may be a clinical reason, or the question may not have come up. A second opinion from a molecular oncologist is a reasonable step if you want independent advice on whether testing is warranted.